ABSTRACT
We report a retrospective study of 17 patients with systemic lupus erythematosus who were treated with oral methotrexate given as a mean weekly dose of 8.47 +/- 1.72 mg. Methotrexate treatment resulted in symptomatic improvement in 57% of patients and allowed the reduction of the mean daily dose of prednisone from 16.66 mg initially to 8.99 mg at one year follow-up. Twelve of 17 patients (70.6%) experienced at least one episode of toxicity. Factors which might be associated with toxicity are analyzed. Because of its potential as a corticosteroid-sparing agent, controlled studies of methotrexate for the treatment of systemic lupus erythematosus are indicated.
Subject(s)
Lupus Erythematosus, Systemic/drug therapy , Methotrexate/therapeutic use , Adult , Dose-Response Relationship, Drug , Female , Humans , Lupus Erythematosus, Systemic/epidemiology , Male , Methotrexate/adverse effects , Middle Aged , Retrospective StudiesABSTRACT
Three patients (one with polymyalgia rheumatica with jaw claudication and two with biopsy-proven giant cell arteritis) were initially treated using prednisone (40-60 mg daily). The response was good in all three, but each experienced exacerbation of symptoms and elevation of Westergren sedimentation rates (WSR) with dose reduction. The addition of methotrexate (7.5-12.5 mg/wk) resulted in diminished symptoms and lower WSR and proved to be steroid-sparing.
Subject(s)
Giant Cell Arteritis/drug therapy , Methotrexate/administration & dosage , Polymyalgia Rheumatica/drug therapy , Aged , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Prednisone/administration & dosageSubject(s)
Giant Cell Arteritis/diagnosis , Aged , Biopsy , Depression/diagnosis , Diagnosis, Differential , Diagnostic Errors , Female , Fever of Unknown Origin/diagnosis , Giant Cell Arteritis/pathology , Humans , Ischemic Attack, Transient/diagnosis , Male , Middle Aged , Muscular Diseases/diagnosis , Neoplasms/diagnosis , Polymyalgia Rheumatica/diagnosis , Temporal Arteries/pathologyABSTRACT
A significant number of patients with rheumatoid arthritis fail to obtain satisfactory disease suppression with conservative therapy. What other means of treatment are available? In what order should they be introduced? What are the potential side effects? The authors address these questions in the following review of management of resistant rheumatoid arthritis.
